Heart Disease & Your Oral Health: <br>What You Need to Know

Heart Disease & Your Oral Health:
What You Need to Know

The health of your heart and the health of your mouth are connected. Heart disease (or cardiovascular disease) increases your risk for serious dental problems like gum disease and oral infections. At the same time, if you have a history of heart disease, oral illnesses may make you more susceptible to future cardiac complications.

The Heart Health & Oral Health Connection

Understanding how heart health and oral health are linked and knowing what you can do to stay proactive can help you take better care of both. MDA dentists share what you need to know about this vital connection for your mouth, heart, and whole body.

Evidence-based research from the American Heart Association, the American Dental Association, and other leading medical bodies links poor heart health to poor oral health. The relationship goes the other way, too. Poor oral health, specifically gum disease, increases the risk of developing heart disease1.

Experiencing dental problems like tooth loss, gum disease, and chronic dry mouth, can impact your heart health. If you already have heart disease, these conditions can increase your risk of developing life-threatening complications2. These risks increase with age. For adults and adolescents with heart conditions, looking after your oral health can help protect your heart health, too.

The Oral Complications of Heart Disease

Whether you or someone you love lives with heart disease, this diagnosis can greatly impact your day-to-day life. Managing heart disease often means making significant lifestyle changes, impacting everything from your diet to your activity level. Several conditions may fall under the name “heart disease3” (or cardiovascular disease), including:

  • Congenital Heart Disease (CHD)
  • Coronary Artery Disease (CAD)
  • Heart Arrhythmias
  • Heart Failure
  • Heart Muscle Disease (Cardiomyopathy)
  • Heart Valve Disease
  • History of Heart Attack
  • Endocarditis/ History of Endocarditis
  • Pericardial Disease

All these heart conditions impact your overall health, including your oral health. Many cardiovascular medications and surgical procedures can affect your mouth4. Surgeries and medications can lower your body’s ability to fight oral bacteria and slow healing in the mouth. Many medications also lead to dry mouth, which contributes to tooth decay, cavities, and other oral illnesses.

HEART MEDICATIONS & PROCEDURES SAVE LIVES:

Side-effects from medications and delayed healing from procedures can impact your oral health. However, heart medications and surgeries save lives. As part of your health care team, your MDA dentist may work with your cardiologist to help you take additional steps to protect your oral health from these compilations.

Linking Heart Disease & Gum Disease — Inflammation & Infection

A growing body of research suggests that a common link between heart disease and gum disease is chronic inflammation5. Inflammation is an underlying symptom of most heart conditions. It’s one of the main contributors to the development of gum disease, as well as a by-product of gum disease, which is an active infection. Together with other health and lifestyle factors, inflammation connects gum disease and heart disease to such an extent that having one increases the risk of developing the other1.

What Is Inflammation?

Inflammation is the immune system’s natural response to fighting illness, infection, and disease. Biologically, it’s designed to be short-lived. But it can become chronic when you fight an ongoing infection (such as gum disease) or live with a serious health condition (such as heart disease). Eventually, chronic inflammation impacts your whole body. That includes your immune system, blood vessels, heart, and even your mouth, teeth, and gums5.

Connecting Gum Disease & Infective Endocarditis

Both gum disease and heart disease increase your risk of developing infective endocarditis (IE), a life-threatening bacterial infection in the heart. Gum disease is an inflammatory disease and an active infection. As with any infection, the worse it becomes, the more easily it can spread.

  • Gum Disease: is a bacterial infection of the soft tissue of the gums that leads to the deterioration of your gums and teeth. When left untreated, gum disease causes tooth loss and jawbone loss. As an active infection, gum disease creates a pathway for oral bacteria to enter the bloodstream. Where it can spread to other areas of the body, including the heart6.
  • Infective Endocarditis (IE): is a bacterial infection of the heart. Some instances of IE may originate in the mouth. When oral bacteria from gum disease (or other dental infections) enter the bloodstream, they circulate back to the heart. There, they cause serious complications. Tissue damage from IE can cause or complicate existing heart disease7. If left untreated, IE can become life-threatening.

Routine dental care and prompt treatment at the first of signs of gum disease help prevent IE in those with heart disease. Treatment for gum disease, especially advanced gum disease (periodontitis), can take a toll on your body. MDA dentists may recommend breaking gum disease treatment into sessions to reduce the stress and strain on your immune and cardiovascular systems1,8.

Gum Disease Prevention Protects Your Heart

Prevention is always less taxing on your body than treatment. That’s why maintaining a good at-home daily oral care routine focusing on gum disease prevention is so important for your mouth and your heart9. After all, preventing gum disease means protecting your heart. And protecting your heart means preventing gum disease.

DENTAL PLAQUE & HEART DISEASE:

Dental plaque contains millions of oral bacteria. When those bacteria enter the bloodstream, they can contribute to IE10. MDA dentists and hygienists remove plaque buildup at regular dental cleanings. Reducing oral bacteria through plaque removal helps protect your oral and overall health.

Dental Considerations for People with Heart Disease

Routine dental care is essential for anyone living with heart disease or at risk of developing heart disease. As medically trained experts, MDA dentists take certain precautions and preventive measures into account when treating those with heart disease.

Your MDA dentist may consult directly with your primary care provider or cardiologist to ensure you receive the most accurate treatment based on your existing heart conditions.

When you visit your MDA dentist, inform them and their dental team of any ongoing or new diagnoses and medications. Your specific diagnosis, medications, and medical history will inform how they approach your personalized care. Here are some tips to keep in mind for your next visit:

  • Medications: Bring a full list of current medications and dietary supplements with you to your dental appointment. Tell your dental care team if you take anticoagulants or antiplatelet medications.
  • Surgeries & Procedures: Preparing for heart surgery? You might need dental clearance first to rule out abscesses, infections, or gum disease. Oral infection can increase the risk of complications, including heart attack10. You may need to have cavities, gum disease, and other oral illnesses treated before undergoing an elective heart procedure.
  • Antibiotics: MDA dentists may prescribe antibiotics to prevent IE in those considered high-risk. This includes anyone with heart valve replacements or those who have had certain heart valve repair procedures. It also includes those with a history of IE, anyone with Congenital Heart Disease (CHD), and heart transplant recipients11,12.
  • Blood Pressure: Let your dental care team know if you have a history of high or low blood pressure. They may take your blood pressure when you arrive and at other points during your visit.

There are also in-office precautions your MDA dentist will take to ensure a safe, comfortable visit. These may include exploring alternatives to instruments that might disrupt pacemakers or using certain medications (anxiolytics) to moderate heart rate during procedures13.

Above all, your MDA dentist will prioritize understanding your relationship with heart disease and how it impacts your oral health. You and your MDA dental care team can create a personalized treatment plan that considers your specific conditions and any concerns you have.

Heart Disease & Your Daily At-Home Oral Care Routine

Managing heart disease is part of everyday life for many Michiganders. Oral care is too. Incorporating healthy daily oral care habits goes a long way toward reducing the risk of developing gum disease, infection, and oral health-linked cardiovascular complications.

MDA dentists recommend:

  • Brushing twice a day and flossing daily.
  • Using a prescription mouthwash or antibacterial rinse before bed to lower bacteria levels in your mouth.
  • Visiting your MDA dentist and their team regularly for cleanings to prevent gum disease and eliminate plaque buildup.
  • Making sure dentures fit properly to reduce any risk of sores that could lead to infection.
  • Checking teeth, tongue, cheeks, and gums regularly for areas of redness, inflammation/infection, or pain.
  • Reducing sugar intake—especially sweet drinks like juice and pop—and avoiding processed foods to help prevent cavities and excess inflammation.
  • Avoiding tobacco products entirely. No cigarettes, vapes, chewing tobacco, or cigars.
  • Eating heart-healthy and mouth-friendly foods, including plenty of fresh fruits and vegetables.

Simple, consistent, daily oral care habits are the key to improving and caring for your oral health14. According to the American Heart Association, good daily oral care habits and routine dental care are the best defense for preventing IE11.

Take Charge of Your Oral Health for Your Heart Health

Your cardiologist is a key partner in managing your cardiovascular condition. Talk to your MDA dentist about how they can do the same for your oral health—and, by extension, your heart health!

If you don’t have an MDA dentist, use the MDA’s Find-A-Dentist tool to find one near you. At your next visit, tell your dental care team about any medication, diagnosis, recent and planned surgeries, and concerns you may have. They’ll do everything they can to ensure your dental care experience is comfortable. Together, they’ll take care of your oral health for your heart health.

References:

  1. Tonetti MS and Graziani F. “The Cardiovascular System and Oral Infections” in Glick M ed, The Oral-Systemic Health Connection: A Guide to Patient Care. Second Edition. Quintessence Publishing; Batavia, IL: 2019.
  2. Kotronia E, Brown H, Papacosta AO, et al. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Sci Rep. 2021 Aug 12;11(1):16452. Accessed online: doi: 10.1038/s41598-021-95865-z
  3. American Heart Association (AHA). What Is Cardiovascular Disease? AHA; Reviewed 31 May 2017. Accessed online:
    https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease
  4. Nalliah, R, Basu T, Chang CH. Association between periodontal care and hospitalization with acute myocardial infarction. J Am Dent. 2022;153(8):776-786. Published 19 Apr 2022. Accessed online: https://doi.org/10.1016/j.adaj.2022.02.003
  5. Oindrila, P, Arora P, Mayer M, Chatterjee S. Inflammation in periodontal disease: Possible link to vascular disease. Front Physiol. 2021 Jan 14;11:609-614. Accessed online: doi: 10.3389/fphys.2020.609614
  6. Zardawi F, Gul S, Abdulkareem A, et al. Association between periodontal disease and atherosclerotic cardiovascular diseases: Revisited. Front Cardiovasc Med. 2021 Jan 15;7:#625579. Accessed online: https://doi.org/10.3389/fcvm.2020.625579
  7. Cleveland Clinic. Oral Health & Risk for CV Disease. Reviewed 14 July 2017. Accessed online:
    https://my.clevelandclinic.org/health/articles/11264-oral-health–risk-for-cv-disease
  8. Sanz M, del Castillo AM, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontal. 2020;47(3):268-288. Published 03 Feb 2020. Accessed online: https://doi.org/10.1111/jcpe.13189
  9. Ryden L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of a first myocardial infarction: a report from the PAROKRANK Study. Circulation. 2016;113(6)576-583. Published 13 Jan 2016. Accessed online: https://doi.org/10.1161/CIRCULATIONAHA.115.020324
  10. Carinci M, Martinelli M, Contaldo R, et al. Focus on periodontal disease and the development of endocarditis. J Biol Regul Homeost Agents. 2018;32(2):143-147. Published March 2018. Accessed online: https://pubmed.ncbi.nlm.nih.gov/29460534/
  11. Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143:e963–e978. Accessed online: https://doi.org/10.1161/CIR.0000000000000969
  12. American Dental Association (ADA). Antibiotic Prophylaxis Prior to Dental Procedures. Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC. Updated 05 Jan 2022. Accessed online:
    https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/antibiotic-prophylaxis
  13. Sing S. Gupta K, Garg KN, Fuloria NK. Dental management of the cardiovascular compromised patient: a clinical approach. Journal of Young Pharmacists. 2017;9(4)453-456. Accessed online: https://jyoungpharm.org/article/1036
  14. Park SY, Kim SH, Kang SH, et al. Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: a population-based study from Korea. Eur Heart J. 2019;40(14):1138-1145. Published 17 Apr 2019. Accessed online: https://doi.org/10.1093/eurheartj/ehy836

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